Lambda sign and T sign

 

Twin pregnancy

: increased age and parity

Family history of twins

Treatment for infertility 

2 varieties:dizygotic and monozygotic

MZ twins are of the following variety depending on the time of twinning

1-within 72hrs of fertilization =dichorionic, diamniotic

2-between 4th and 8th day= monochorionic, diamniotic

3-between 8th and 12th day=monochorionic, monoamniotic

4-after 12days=siamese or conjoint twins

Signs for chorionicity on USG:

Dichorionicity:twin peak/lambda sign

Monochorionicity: T sign/inverted T sign

Maternal complications:

Anemia

Hyperemesis

Pre-eclampsia 

Preterm labor

PPH

Twin complications:

Conjoined twinning

Twin to twin transfusion syndrome

Acardiac twin

Discordant growth

-Rudrani. 

Atenolol in pregnancy and breastfeeding

Atenolol is contraindicated in pregnancy.

Where does this data come from?

Biophysical Profile Mnemonic

 

Biophysical Profile 

Just add an extra “V” 

See the management here .. 

https://www.medicowesome.com/2016/09/biophysical-profile-mnemonic-and-step-2.html

See the video here https://www.medicowesome.com/2018/03/nonstress-test-and-biophysical-profile_6.html 

“ The value of experience is not in seeing much, but in seeing wisely”.  - William Osler  

Thank you! 🩺

Levetiracetam - pregnancy considerations

 Hi!

Levetiracetam, used primarily for seizures control, is also used off-label for SAH, status epilepticus, seizure prophylaxis in craniotomy and traumatic brain injury.

Dosing is increased in pregnancy and closely monitored regularly due to various physiologic effects, especially in third trimester. (levitate dose of levetiracetam) :-

- increased volume of distribution, Vd (increase in plasma volume, CO)

- increased renal excretion (increase in GFR; levitate the rate)

- rapid and almost complete absorption via GIT  (unlike other drugs with decreased absorption in pregnancy)

- low risk of adverse effects and fetal malformations when used in monotherapy. (low with mono, high with poly)

- Levetiracetam is NOT metabolized by liver; Cyt P450 independent. Bioavailability 100%. (unlike other antiepileptics - hepatic metabolism increases in pregnancy)

Levetiracetam crosses placenta and can be detected in the newborn. (leve leaves mother)

The newborns are at greater risk of SGA and low APGAR score.

Protein-binding of the drug is low (<10%). So, decrease in albumin concentration during pregnancy does not significantly affect the drug concentration. (low pro)

That's all

- Jaskunwar Singh

Toxoplasmosis classic triad mnemonic

 Hi!

Toxoplasmosis classic triad in neonates mnemonic: CATS 

- CAlcifications (intracranial)

- Tension hydrocephalus

- See (Chorioretinitis)

Also, check out this video mnemonic by IkaN

- Jaskunwar Singh

Fetal heart rate tracing | Mnemonics, Concepts & Management | High yield...

Contraception

 CONTRACEPTION 

Cu-T INSERTION 

REQUIREMENTS:  

Written Informed consent, IUD, Povidone Iodine, Spirit and drapes, Sims’s speculum, Allis forceps, Uterine Sound 

 

PROCEDURE: 

• Begin with the history and clinical examination to rule out contraindications. 

• Before inserting the IUD, always do UPT to rule out pregnancy. 

• The patient is taken up in the OT (but can be done in OPD or labour ward immediately post-partum). An anaesthetist should be present if in case perforation occurs. 

• POSITION: Standard lithotomy position with legs in stirrups. 

• Scrubbing, painting, and draping should be done. 

• Bimanual examination to check for uterine size, position, version, and adnexal pathology. 

• Depress posterior vaginal wall with Sim’s speculum and hold the anterior lip of cervix using Allis forceps. 

• Using uterine sound, measure utero-cervix length and the accordingly adjust the bobbin. 

• The technique used is “No Touch/ Withdrawal technique”. 

• CuT is self-loaded. Remove the whole thing without touching CuT. 

• Plunger should not touch the vaginal wall. Reach upto the uterine fundus. Pull the ring behind on the plunger. CuT is unfolded. 

• Slowly remove the loader so as not to disturb the CuT. 

• Cut the tail (2.5-3 cm). The patient should be made to feel the tail. 

• Observe for about half an hour for uterine cramps (since foreign body inserted so uterus tries to expel it)  

Managed by giving Drotaverine/Dicyclomine. 

 

• Record the date of insertion. Document it on CuT card and mention the date of expiry. Give it to the patient. 

• Counsel the patient regarding all the possible complications and also regarding the follow-ups. 

 

ANTARA 

Injectable Contraceptive DMPA (Under ANTARA programme) given as i.m. injection on outer upper quadrant of buttock. 

Dose: 150 mg every 3 months  

Written by our guest author - Ayushi Gupta

Illustration by Devi Bavishi

#Ae(ONE)INTERN

Cardiotocography

 CARDIOTOCOGRAPHY

CTG machine has two sensors:

 

• Cardio probe: placed on the mother’s abdomen at the foetal anterior shoulder to measure the foetal heart rate. 

• Toco probe: placed on the mother’s fundus to record uterine muscle contraction.  

(Jelly is to be applied between the probe and the site of application of the probe)

 

CTG paper moves at rate of 3cm/min 

Therefore 1cm = 20 sec on x-axis

        

Also 1 cm = 10 bpm on Y axis

To be taken every 2 hours towards the end of pregnancy.

 When analysing a CTG look for 4 things: 

     1.      Baseline heart rate

     2.      Beat to Beat variability 

     3.      Accelerations

     4.      Decelerations 

1. Foetal Heart rate: Normal: 110-160 bpm 

2. Beat to beat variability:  Normal: 5-25bpm showing saw tooth pattern      

3. Foetal accelerations: 

• Abrupt increase in FHR above baseline. 

• If a rise of 15 bpm persists for 15 sec or more but less than 2 mins is seen twice during a 20 min period then this is adequate contractions or REACTIVE (after 32 weeks). 

 

4. Foetal decelerations: 

• Decrease of 15 bpm in FHR for ≥15 seconds  

• Time from onset of the deceleration to the lowest point of the deceleration >30 seconds in variable decelerations.

  
  

  
  
  

• Early decelerations: Cause: pressure on the foetal head during labour (normal)

 

• If late or variable decelerations are present, call a senior. 

 

    If all 4 parameters normal: REASSURING NST 

    If any 1 abnormal: SUSPICIOUS NST  

    If any 2 or more abnormal: PATHOLOGICAL NST 

 

If CTG is non-reassuring: 

• Set up IV line

• Start RL/Oxygen 

• Give left lateral position

• Call the resident

• Stop oxytocin

• Ask sister to give OT changes/scrubs  

Written by our guest author - Yash Bandewar and Anveshi Nayan

Illustration by Devi Bavishi

#Ae(ONE)INTERN

 

 

 

  

Mnemonic for Thanatophoric dysplasia (thanatophoric dwarfism)

Welcome! 

A lethal skeletal dysplasia. It is the most common lethal skeletal dysplasia followed by osteogenesis imperfecta type II. 

Mutation of fibroblast growth receptor 3 (FGFR3) gene 

Type 1 : telephone handle like femurs

Type 2 : presence of a cloverleaf skull. Limb shortening milder and bowing is not there. 

Mnemonic : PCR

P = Platyspondyly (flattened vertebral bodies) 

C = Cloverleaf skull

R = Rhizomelic dwarfism , Rib cage is small 

Rhizomelic dwarfism Proximal (i.e. femoral, humeral) limb shortening.

Present as Nonviable fetus ....so do spontaneous vaginal delivery!

Thank you!

Mnemonic for pregnancy complications with short inter pregnancy interval

Definition : <6-18 months from delivery to next pregnancy

During pregnancy, maternal folate and iron are depleted for fetal development, and the resulting maternal anemia is exacerbated by normal blood loss during delivery (eg, up to 10%-20% of blood volume).  In breastfeeding women, continued nutritional demands from the newborn prevent repletion of normal folate and iron stores, resulting in prolonged anemia!

#23 Abnormal Labour

#22 Labour Part 2

#21 Labour Part 1

 

 

Let's revise MBBS podcast: #19 Fetus in the Uterus

Video by Ayush Dhoka

Let's revise MBBS podcast: #20 Maternal Pelvis

Video by Ayush Dhoka

Let's revise MBBS podcast: #18 Rh Negative Pregnancy

Video by Ayush Dhoka

Naegele's formula

 Naegele's formula

The Naegele's formula is a simple arithmetic method for calculating the EDD (estimated date of delivery) based on the LMP (last menstrual period). 

To the date of the first day of the LMP (e.g. 22nd June 2019):

• add seven days (i.e 29th)

• subtract 3 months (i.e March)

• add one year (i.e 2020)

Note: If the interval of cycles is longer, the extra days are to be added and if the interval is shorter, the lesser days are to be subtracted to get the EDD.

Breastfeeding: The Mother & Baby Bond

In today's fast pacing era what can be most necessary and unaltered for a new guest in this world. What can be a moving experience from a women's point of view. Definitely it's breast feeding. An Emotional saga for every women's life. An experience to be relished lifelong. It's not only a rational experience rather a lifetime experience for her. 

From the beginning of human settlements many things have changed but not this loving and caring bond between a mother and her child. The happiness felt by a mother during the nourishment of her newborn is unmeasurable.  She forgets all her pain and discomfort in front of this joy. This is the reason why mothers are portrayed as goddess in every religion and culture.

Apart from these aesthetical values there are many Scientific theories which proves why breastfeeding is important and is considered as an emotional experience. Mother’s milk is highly nutritious and contains varieties of Carbohydrates, protein, vitamines and immune boosting complexes which are sufficient for the growth of baby in 1st six months of life. 

During the process of breast-feeding maternal pituitary releases prolactin and oxytocin. These hormones along with increasing the milk production help in reducing mental anxiety of mother. 

Thus the first connection of baby to her mother is undoubtedly important and can't be substituted. If this process is ever altered I think our existence will be questioned. 

By- Sudipt Anand (S.K.M.C.H)

Breastfeeding: An Emotion

What can be so pure and good for a newly born baby. The first food of the baby is breast milk or mother’s milk. It is the only food the baby can consume. It's not only only a physical process but an emotional and mental process also. Mother and her child goes through an emotional and hormonal change during the process which is beyond the scope of science to feel it.This helps baby to grow and get nourishment.

Health professionals recommend that breastfeeding must begin within the first hour of a baby's life and continue as often and as much as the baby wants. During the first few weeks of life babies may nurse roughly every two to three hours, and the duration of feeding is usually ten to fifteen minutes on each breast. Older children feed less often. There are multiple advantages of breast-feeding to the child and to the mother also.

1) Nutritional superiority - Breast milk contains all kind of nutrients required for a baby's proper mental and physical growth.                     

a) Carbohydrates -  Lactose is present in the breast milk they help in growth of lacto bacilli in the intestine and also help absorption of calcium. Galactose found in the milk help in formation of galactocerebrosides. 

b) Fats - Breast milk contains omega 2&6 fatty acids which are necessary for synthsis of cholesterol and prostaglandins. The PUFA content of milk help in mylination of nerve fibers. It also contains DEHA, which help in brain and retina formation. 

c) Protein - The protein present in the milk are easily digested. These proteins help in neuromodulation and neuro transmission. 

d) Water -  Breast milk contains enough water and electrolytes in them to fully satisfy baby's need. 

e) Vitamins -  The vitamins present in the milk is sufficient for babies first 6 month of life. 

2)Immunological Benefits -  Breast milk contains a number of Immunological benificial factors which help baby in their protection against diseases. 

. PABA = It protect against malaria. 

. Lactoferrin = It protects against E.Coli

. Lipases = It protects against Intestinal pathogens

. It also contains Lactglobulins, Lysozyme, Lactalbumin and Immunoglobulin mainly IgA. 

 

3) Mental Growth = Studies have shown that breast feed babies have higher IQ and and are more attached to mother that who recieve other form of milk. 

4) Protection against allergies = Babies are highly exposed to risk of allergies due to their low immunity which is supplement by the immunity gained from mother’s milk. 

5) Benefits to Mother = Breast-feeding soon after delivery helps in involution of uterus and prevent postpartum haemorrhage. Breast feeding also reduces the chance of ovarian and breast carcinoma. It also help mother in preventing pregnancy for next 6 months. It also help mothers by helping them to loose extra weight that is gained during pregnancy. 

Thus Breast-feeding is a convenient and best way of raising a healthy baby. It helps to build a special and beautiful relation between a mother and her baby.  

Thank you

Sneha Kashyap

2nd year MBBS

GMC BETTIAH